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Goodbye for now…

So, it’s been quite a long time since I’ve posted at all regularly here. It’s time I bite-the-bullet and admit it’s going to be a while before I find the time to get back to blogging.

Thanks to everyone for reading and commenting. Feel free to keep the blog in your RSS reader — I will come back and blog here again sometime.

In the meantime, if you’re interested, you can find what I’m writing for New Scientist here. And you can keep up with other stuff I might be doing here.

Of course, you can follow me on twitter too @mikeyslezak.

Goodbye for now!

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Alternative medicine “butt” of serious joke

If you wrote to the organising committee of a scientific conference saying that you have a theory that there is a person in everyone’s bum and if you massage it in the...

If you wrote to the organising committee of a scientific conference saying that you have a theory that there is a person in everyone’s bum and if you massage it in the right way, you can cure many illnesses, do you think you would be invited to give a paper to the conference?

Perhaps if you were invited, you might justifiably conclude that the discipline that the conference is in is a pile of rubbish. Or, at least, that the organisation that is hosting the conference is made up of a bunch of quacks.

Well, one professor of medical education in the UK proposed exactly this as a topic for a paper to a “Complementary and Alternative Medicines” conference in Jerusalem. And, to his surprise, he was invited to give a paper.

His conclusion is very nicely expressed:

So called integrative medicine should not be used as a way of smuggling alternative practices into rational medicine by way of lowered standards of critical thinking. Failure to detect an obvious hoax is not an encouraging sign.

He recounts the story in the British Medical Journal‘s Christmas edition, which is full of stuff that’s meant to be entertaining. His article is indeed entertaining and worth a read.

Check out his original pitch in which he subtly alludes to butt-kissing (“gentle suction”):

Recently, as a result of my developmental studies on human embryos, I have discovered a new version of reflexology, which identifies a homunculus represented in the human body, over the area of the buttocks. The homunculus is inverted, such that the head is represented in the inferior position, the left buttock corresponds to the right hand side of the body, and the lateral aspect is represented medially. As with reflexology, the “map” responds to needling, as in acupuncture, and to gentle suction, such as cupping. In my studies, responses are stronger and of more therapeutic value than those of auricular or conventional reflexology. In some cases, the map can be used for diagnostic purposes.

The idea of pulling a hoax to point out the absurdity of disciplines has a great history, which this hoaxster is aware of. He (somewhat self-flatteringly) compares his little stunt to the Sokal hoax in which Alan Sokal famously revealed the absurdity of postmodernist cultural studies by submitting a ridiculous paper to a respected journal and having it published.

If you haven’t read about the Sokal hoax, do some googling. Sokal has also recently written a book about the hoax and other related things that is on my summer reading list…

[Via Cardiology Update]

ResearchBlogging.org McLachlan JC (2010). Integrative medicine and the point of credulity. BMJ (Clinical research ed.), 341 PMID: 21147748

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Mythbusting booze: Absorbing alcohol through feet?!?

Yeah — I didn’t think this was a belief that anyone held either. But apparently it’s Danish urban folklore that you can become drunk by submerging your feet in an...

Yeah — I didn’t think this was a belief that anyone held either. But apparently it’s Danish urban folklore that you can become drunk by submerging your feet in an alcoholic beverage. At least, that’s what three Danish researchers say in the British Medical Journal.

These three guys decided, in the spirit of early science, to test the putative myth on themselves.

They sat with their feet in a laundry tub full of vodka for three hours and measured their blood-alcohol levels every three hours.

Unsurprisingly, they found that there were no significant changes in blood alcohol levels and they provide the following sober conclusion.

Our results suggest that the transcutaneous intake of alcohol (vodka, 37.5% by volume) through feet is not possible. We therefore conclude that the Danish urban myth about being able to get drunk by submerging feet in strong alcoholic beverages is just that; a myth.

ResearchBlogging.org Christian Stevns Hansen, Louise Holmsgaard Færch, Peter Lommer Kristensen (2010). Testing the validity of the Danish urban myth that alcohol can be absorbed through feet: open labelled self experimental study The British Medical Journal : 10.1136/bmj.c6812

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Doctors arguing badly: the ethics of placebos

The ethics of conducting medical trials can be tricky. There is always the risk someone could be exposed to a drug that is dangerous, or they could miss out on...

The ethics of conducting medical trials can be tricky. There is always the risk someone could be exposed to a drug that is dangerous, or they could miss out on something of potential benefit.

So these issues need debating in medical journals.

But doctors and medical researchers are not ethicists and this was, I think, demonstrated by an article recently in the prominent journal The New England Journal of Medicine.

So bad was an argument made by these experts, that it’s really worth thinking about for a minute.

» The issue

The debate was about whether or not it is ethical to conduct placebo controlled trials of drugs that treat osteoporosis. The trouble is that we now have very good drugs that significantly reduce the rates of fractures, and giving someone a placebo is denying them something that will do them a great deal of good.

This problem needs to be weighed against the fact that controlled trials are needed to develop newer, better drugs. So, you can see that there is an issue here that needs to be debated.

One of the central questions, is whether there are alternative ways of trialling new drugs, without using placebos. One such way is to compare new drugs to existing drugs: “head-to-head trials”.

But the practical problem with conducting head-to-head trials is that they need to be much larger in order to show statistically significant effects.

» The good argument

In one article in the journal, two doctors said that this practical concern doesn’t matter.

The challenges associated with head-to-head trials “should not be considered an ethical justification for administering placebo to some patients, which would result in potentially preventable fractures,” they said.

This seems to me to be a good argument. The underlying principle is that the alternative to a course of action being practically difficult, doesn’t make that action ethical. Just because doing head-to-head trials is difficult doesn’t mean that giving people placebos is ethically OK.

» The bad argument

But the guys arguing that placebo trials can still be ethical in osteoporosis expected this argument, and rebutted it with what I think is one of the worst ethical arguments I have come across in a medical journal.

Ultimately, any trial involving [an active] comparison group would, given its necessarily larger size, result in more fractures over the duration of the trial than would be observed in a placebo-controlled study and, thus, it would offer no ethical advantage over the latter.

It seems to me that they’re defending the principle that the primary ethical consideration is the total number of negative outcomes observed in a trial.

That’s what they’re saying, right? Read it again:

…would, given its necessarily larger size, result in more fractures over the duration of the trial than would be observed in a placebo-controlled study and, thus, it would offer no ethical advantage over the latter.

But that is an absurd principle to defend. On the basis of that principle, if we were to do a large trial where we gave patients the very best care we know of, it could be unethical because if it’s large enough, it will observe a lot of negative outcomes.

Indeed, it would be an argument against collecting data on real-world outcomes in what are known as “observational studies”. If you observe a million people, then there will be lots of negative outcomes. But that clearly doesn’t make observing them unethical.

I put this point to the lead author in an email. I received a very nice and thoughtful reply, but I don’t think any light was shed on the matter. (I’ll post the reply in the comments.)

» The relevant ethical principle

Giving a placebo to 100 people, and seeing 5 negative outcomes is worse than giving best treatment to 100,000 people and seeing a few more negative outcomes.

The relevant issue is not the number of negative outcomes, but the risk of negative outcomes being imposed on each patient. It’s about the intervention we’re making, and whether that is ethical.

So we need to make sure we’re not giving people placebos when they could benefit from an active treatment and we need to make sure that active treatments we are trialling are likely to be safe and effective. We can never be sure, but with these matters, it’s always about the risk — the probability of harm.

ResearchBlogging.org Stein CM, & Ray WA (2010). The ethics of placebo in studies with fracture end points in osteoporosis. The New England journal of medicine, 363 (14) PMID: 20879888

ResearchBlogging.org Rosen CJ, & Khosla S (2010). Placebo-controlled trials in osteoporosis–proceeding with caution. The New England journal of medicine, 363 (14) PMID: 20879887

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